Health Information Management

Q&A: Report appropriate device codes when procedures are device-dependent

APCs Weekly Monitor, May 16, 2008

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QUESTION: We are negotiating to provide pain stimulator services. We will report code 63650 for the trial and codes 63685 and 63650 for the permanent. According to everything we have read from CMS, our claims will be processed per the hospital OPPS because it is a device-intensive procedure. Our vendor told us that we should include implants in our CPT code(s) and that we should not bill for them. According to the OPPS, we should bill them separately. Can you provide us with a definitive answer?
 
ANSWER: According to the Calendar Year (CY) 2008 OPPS final rule (CMS-1392-FC), CPT code 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) and CPT code 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) are assigned to device-dependent APC 0040 and device-dependent APC 0222, respectively. You can find the listing of device-dependent APCs and the associated median costs for CY 2008 in Table 24 of the final rule. 
 
Because these CPT codes are assigned to device dependent APCs, CMS will reject these claims if you do not report the appropriate device code on the claim. CMS publishes an updated listing of procedure-to-device edits and device-to-procedure edits on its Web site each quarter. These lists indicate which procedure CPT codes require a device code on the claim and which device codes require a corresponding procedure CPT code reported with them. 

For example, when you report code 63650 on an outpatient claim, CMS will edit for the presence of HCPCS code C1778 (lead neurostimulator) or code C1897 (lead neurostim test kit). If one of these device HCPCS codes is not present on the claim, CMS will return the claim to the provider for correction. Similarly, code 63685 requires the presence of a neurostimulator generator HCPCS code (C1767 or C1820) or the claim will not process.  Facilities must report the appropriate device code when a procedure is considered to be device-dependent in order for the claim to pass the OCE edits.

Click here to view the device edits on the CMS Web site.



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